Predictors of restenosis following contemporary subintimal tracking and reentry technique

The importance of final TIMI flow grade

Mauro Carlino, Filippo Figini, Neil Ruparelia, Barry F. Uretsky, Cosmo Godino, Azeem Latib, Letizia Bertoldi, Emmanouil Brilakis, Dimitri Karmpaliotis, David Antoniucci, Alberto Margonato, Antonio Colombo

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives: To identify predictors of restenosis after recanalization of chronic total occlusions (CTOs) with the Subintimal Tracking And Reentry (STAR) technique. Background: STAR is associated with high rates of restenosis but the associated factors are not clear. Understanding the underlying mechanisms may be important to improve STAR outcomes and possibly other contemporary CTO recanalization techniques utilizing extensive subintimal dissection and stenting. Methods: We retrospectively analyzed 211 lesions that underwent a STAR procedure (between 2002 and 2013) with a final Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3. One-hundred and nineteen lesions that received drug eluting stents (DES) and underwent follow-up angiography were included in the final analysis. Results: Of the 119 lesions treated with DES following STAR, 75 restenoses were observed (63.0%). Utilizing multivariate analysis, TIMI flow grade in the recanalized artery following stent implantation at the end of the index procedure was the only independent predictor of restenosis. Conclusions: Following recanalization of a CTO with STAR, final TIMI flow predicted future restenosis or reocclusion. As a bailout technique, STAR resulted in a high acute success rate with good safety and acceptable long-term results. When poor flow is observed following recanalization, and prior to stent implantation, a two-step strategy whereby a second procedure is performed at an interval to maximize coronary flow at the end of the procedure may be considered with the goal to reduce the risk of future restenosis or total vessel occlusion following STAR.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
DOIs
Publication statusAccepted/In press - 2015

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Myocardial Infarction
Drug-Eluting Stents
Stents
Dissection
Angiography
Multivariate Analysis
Arteries
Safety

Keywords

  • Chronic total occlusion
  • Coronary stenting
  • Percutaneous coronary intervention
  • Restenosis
  • TIMI flow

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Predictors of restenosis following contemporary subintimal tracking and reentry technique : The importance of final TIMI flow grade. / Carlino, Mauro; Figini, Filippo; Ruparelia, Neil; Uretsky, Barry F.; Godino, Cosmo; Latib, Azeem; Bertoldi, Letizia; Brilakis, Emmanouil; Karmpaliotis, Dimitri; Antoniucci, David; Margonato, Alberto; Colombo, Antonio.

In: Catheterization and Cardiovascular Interventions, 2015.

Research output: Contribution to journalArticle

Carlino, Mauro ; Figini, Filippo ; Ruparelia, Neil ; Uretsky, Barry F. ; Godino, Cosmo ; Latib, Azeem ; Bertoldi, Letizia ; Brilakis, Emmanouil ; Karmpaliotis, Dimitri ; Antoniucci, David ; Margonato, Alberto ; Colombo, Antonio. / Predictors of restenosis following contemporary subintimal tracking and reentry technique : The importance of final TIMI flow grade. In: Catheterization and Cardiovascular Interventions. 2015.
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abstract = "Objectives: To identify predictors of restenosis after recanalization of chronic total occlusions (CTOs) with the Subintimal Tracking And Reentry (STAR) technique. Background: STAR is associated with high rates of restenosis but the associated factors are not clear. Understanding the underlying mechanisms may be important to improve STAR outcomes and possibly other contemporary CTO recanalization techniques utilizing extensive subintimal dissection and stenting. Methods: We retrospectively analyzed 211 lesions that underwent a STAR procedure (between 2002 and 2013) with a final Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3. One-hundred and nineteen lesions that received drug eluting stents (DES) and underwent follow-up angiography were included in the final analysis. Results: Of the 119 lesions treated with DES following STAR, 75 restenoses were observed (63.0{\%}). Utilizing multivariate analysis, TIMI flow grade in the recanalized artery following stent implantation at the end of the index procedure was the only independent predictor of restenosis. Conclusions: Following recanalization of a CTO with STAR, final TIMI flow predicted future restenosis or reocclusion. As a bailout technique, STAR resulted in a high acute success rate with good safety and acceptable long-term results. When poor flow is observed following recanalization, and prior to stent implantation, a two-step strategy whereby a second procedure is performed at an interval to maximize coronary flow at the end of the procedure may be considered with the goal to reduce the risk of future restenosis or total vessel occlusion following STAR.",
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T1 - Predictors of restenosis following contemporary subintimal tracking and reentry technique

T2 - The importance of final TIMI flow grade

AU - Carlino, Mauro

AU - Figini, Filippo

AU - Ruparelia, Neil

AU - Uretsky, Barry F.

AU - Godino, Cosmo

AU - Latib, Azeem

AU - Bertoldi, Letizia

AU - Brilakis, Emmanouil

AU - Karmpaliotis, Dimitri

AU - Antoniucci, David

AU - Margonato, Alberto

AU - Colombo, Antonio

PY - 2015

Y1 - 2015

N2 - Objectives: To identify predictors of restenosis after recanalization of chronic total occlusions (CTOs) with the Subintimal Tracking And Reentry (STAR) technique. Background: STAR is associated with high rates of restenosis but the associated factors are not clear. Understanding the underlying mechanisms may be important to improve STAR outcomes and possibly other contemporary CTO recanalization techniques utilizing extensive subintimal dissection and stenting. Methods: We retrospectively analyzed 211 lesions that underwent a STAR procedure (between 2002 and 2013) with a final Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3. One-hundred and nineteen lesions that received drug eluting stents (DES) and underwent follow-up angiography were included in the final analysis. Results: Of the 119 lesions treated with DES following STAR, 75 restenoses were observed (63.0%). Utilizing multivariate analysis, TIMI flow grade in the recanalized artery following stent implantation at the end of the index procedure was the only independent predictor of restenosis. Conclusions: Following recanalization of a CTO with STAR, final TIMI flow predicted future restenosis or reocclusion. As a bailout technique, STAR resulted in a high acute success rate with good safety and acceptable long-term results. When poor flow is observed following recanalization, and prior to stent implantation, a two-step strategy whereby a second procedure is performed at an interval to maximize coronary flow at the end of the procedure may be considered with the goal to reduce the risk of future restenosis or total vessel occlusion following STAR.

AB - Objectives: To identify predictors of restenosis after recanalization of chronic total occlusions (CTOs) with the Subintimal Tracking And Reentry (STAR) technique. Background: STAR is associated with high rates of restenosis but the associated factors are not clear. Understanding the underlying mechanisms may be important to improve STAR outcomes and possibly other contemporary CTO recanalization techniques utilizing extensive subintimal dissection and stenting. Methods: We retrospectively analyzed 211 lesions that underwent a STAR procedure (between 2002 and 2013) with a final Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3. One-hundred and nineteen lesions that received drug eluting stents (DES) and underwent follow-up angiography were included in the final analysis. Results: Of the 119 lesions treated with DES following STAR, 75 restenoses were observed (63.0%). Utilizing multivariate analysis, TIMI flow grade in the recanalized artery following stent implantation at the end of the index procedure was the only independent predictor of restenosis. Conclusions: Following recanalization of a CTO with STAR, final TIMI flow predicted future restenosis or reocclusion. As a bailout technique, STAR resulted in a high acute success rate with good safety and acceptable long-term results. When poor flow is observed following recanalization, and prior to stent implantation, a two-step strategy whereby a second procedure is performed at an interval to maximize coronary flow at the end of the procedure may be considered with the goal to reduce the risk of future restenosis or total vessel occlusion following STAR.

KW - Chronic total occlusion

KW - Coronary stenting

KW - Percutaneous coronary intervention

KW - Restenosis

KW - TIMI flow

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